Palmoplantar Pustulosis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPalmoplantar PustulosisSCE Dermatology

A 45-year-old man presents with recurrent crops of sterile pustules on his palms and soles on a background of erythema and brown macules (resolved pustules). He is a smoker. He has no evidence of plaque psoriasis elsewhere. What is the most likely diagnosis?

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Correct answer: E — Palmoplantar pustulosis

Palmoplantar pustulosis (PPP) presents with recurrent sterile pustules on palms and soles, evolving through yellow, green-brown, and resolving brown macular stages. It is strongly associated with smoking (>90% of patients are current or ex-smokers). The nosological relationship with psoriasis is debated — it may be a distinct entity. Biologic treatments for psoriasis may paradoxically trigger or worsen PPP. Treatment includes potent topical corticosteroids, hand/foot PUVA, and Acitretin. Dyshidrotic eczema shows deep-seated vesicles rather than superficial pustules.

Reference: BAD 2020 Psoriasis Guidelines; BJD 2019